by Kirsten Hartil
Phrases such as: “the obesity epidemic” and “the war on obesity” have become part of the daily lexicon of biomedical and public health researchers engaged in obesity research. The consequences of framing the discussion this way was the topic of Fat Studies: Bodies, Culture, Health, a panel discussion held at the New School on Monday June 16, 2014.
The four-member panel consisting of professors of clinical psychology, public health, art history, and history was moderated by Dr. Fabio Parasecoli, associate professor and coordinator of the Food Studies Program, the New School for Public Engagement.
The purpose of Fat Studies is to “look at fat as a construction, how fat is being defined, by whom and in what context and what structures are in place that benefit from the commodification of obesity,” explained Dr. Leah Sweet, assistant professor of art history, Parsons the New School for Design. “People are thin, people are tall and people are fat; it’s the negative connotations attached with the word fat that does the damage.”
“Calling people overweight is politically correct, but actually it’s more offensive than calling them fat,” said Dr. Natalia Mehlman Petrzela, assistant professor of history and co-founder of Healthclass2.0, Eugene Lang College, the New School for Liberal Arts. “The word overweight implies that there is a ‘normal’ and that anything ‘over’ that is abnormal.”
“How does one occupy a body and have a valid sense of identity when you are being told your body is invalid? That you are living in something that is not normative,” Dr. Sweet pointed out, drawing analogies with gender, disability and LGBTQ studies.
Weight, Stigma and Discrimination
Weight-based discrimination by teachers, employers, health care professionals and the media is pervasive in the United States; one studyreported prevalence rates comparable to those of racial discrimination. It is completely legal and appears to affect women more than men. Overweight women are more likely to hold lower paying jobs than thinner women and to receive less pay for the same work (reviewed here). Importantly, perceived weight discrimination increases risk for obesity.
The assumption that overweight and obese individuals are solely responsible for their situation because they are lazy, lack self-discipline and overeat is common and has been noted in children as young as three years of age. Dr. Christine C. Caruso, assistant professor at Touro College of Pharmacy, who teaches public health to clinical students, commented that many times students “come in with a very biomedical construction which relates to the sense of personal responsibility; that these issues are produced through lifestyles and choices.” However, Dr. Caruso noted, “this weight-centered biomedical construction of health glosses over the important structural issues of socioeconomic inequality that produce conditions that are closely associated with ill health and excess death.” These structural issues include: access to healthy and affordable food, safe places to be physically active and healthcare.
The “war on obesity,” began in 1994, when Surgeon General C. Everett Koop launched the Shape Up America campaign. However, “we are off in framing many programs with losing weight as the number one goal,” Dr. Petrzela explained. “There’s a lot of energy around wellness and health in schools, but often the proxy for that becomes trashing fat bodies.”
Dr. Lisa Rubin, chair and associate professor of psychology at the New School for Social Research noted that images used to encourage weight loss in children often stigmatize them and contribute to why people dislike their bodies. Showing an image from an American Academy of Orthopedic Surgeons campaign depicting an obese child weighing down one side of a see-saw eating a bag of potato chips, while three normal weight kids play basketball on the other side, with the caption “once, kids played like their lives depended on it. If only kids still did,” she noted that such images reinforce the idea that, “thin kids are active, they’re social, happy and play with other people. Fat bodies are lonely and eat potato chips.”
In a poignant moment during the question and answer session, an audience member shared how as a child he was profoundly impacted by a documentary about the burgeoning obesity epidemic and how he traces his eating disorder struggles back to that.
Body Mass Index, a Poor Surrogate for Defining Health
Epidemiologically and mechanistically, the data is overwhelming that obesity increases the risk of developing type 2 diabetes, cardiovascular disease, and certain cancers. Obesity is defined as having a body mass index (BMI – calculated as: mass in kg / height in meters squared), greater than 30 kg/m2. Overweight is defined as a BMI greater than 25 kg/m2.
However, some individuals can be obese and metabolically healthy (lacking risk factors for cardio-metabolic disease such as elevated blood cholesterol, triglycerides, glucose and high blood pressure), suggesting that BMI may not be the most accurate way to determine an individual’s risk of becoming sick. “It has been estimated that about 10% of adults in the United States have obese BMI and are metabolically healthy, compared with 8% who have a normal BMI and are metabolically unhealthy. In contrast, 26% of adults have normal BMI and are healthy, whereas 21% have obese BMI and are unhealthy,” wrote Rexford S. Ahima and Mitchell A. Lazar in a perspective piece: The Health Risk of Obesity—Better Metrics Imperative, published in Science on August 23, 2013, referring to this 2008 study by Wildman et al.
Along these lines, a number of highly criticized epidemiological studies have described an “obesity-mortality paradox,” where for some people, particularly older people, being overweight confers a health advantage. Both Virginia Hughes in this Nature news feature from May 22, 2013 and the Ahima and Lazar perspective discuss the controversy and possible explanations for the paradox.
So What Can Be Done?
Dr. Caruso works with her clinical students to “think upstream: to stop looking at bodies as these disciplining sites and to take a more systems approach while reframing the discourse so that it’s less weight-centered and more about well being,” thereby shifting the burden of blame from the individual towards the social and environmental factors that promote unhealthy lifestyle choices.
To increase empathy among her design, art, architecture, photography and fashion students, Dr. Sweet sends them out into the neighborhood wearing prosthetics, such as spheres tucked under their shirts, to help them get “out of their own bodies,” and to “open their eyes and think about how design can both empower and disenfranchise people.” For example, stock images used in the media when covering stories on obesity are often photos of headless people, and Dr. Petrzela noted, the design of school desks that can exclude fat people.
Ultimately, the thought-provoking discussion raised the question of whether weight loss-centered programs are the most effective way to encourage people to develop healthier lifestyles and challenged the audience to consider how empowering it is to be told you are fat, sick or ugly or that the body you occupy is invalid or abnormal?
Kirsten received her PhD in clinical biochemistry from Cambridge University, where she studied the developmental origins of health and disease, an area of research she continued when she joined Dr. Maureen Charron’s lab as a postdoc. In 2010 she joined Dr. Irwin Kurland’s lab in the Diabetes Research Center, and used metabolomics and stable isotopes to study metabolic flexibility. In 2012 she decided it was time for a career change and was accepted into the MPH program at Einstein. She hopes to transition into a career working to prevent obesity in people rather than study obesity in mice. She contends, “as scientists we have a responsibility to communicate research in a way that is both understandable and accurate. Being interesting and fun is a bonus. Some people are better at this than others. Contributing to the EJBM blog is my way of sharing stories that I think are important while improving my own writing skills.”